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Abdominal Aortic Aneurysm

An aortic aneurysm is a weak area in the main blood vessel that supplies blood from the heart to the rest of the body. As blood flows through the aorta, the weak area bulges like a balloon. If the balloon grows large enough, there is a danger that it will burst.

The most common site for an aortic aneurysm to occur is below the area where the aorta divides to supply blood to the kidneys and above where it divides to supply blood to the pelvis and legs. An aneurysm in this location is called an abdominal aortic aneurysm (AAA).

A small aneurysm may require no treatment other than checking the aneurysm regularly to be certain it does not grow. If an aneurysm reaches a certain size, however, there is a danger that it will burst and bleed uncontrollably (hemorrhage). In these cases treatment is necessary.

Who Is at Risk?

Those at highest risk for AAA:

• smoke
• have high blood pressure
• have a family history of AAA
• are male
• are over 60 years of age
• have a history of heart disease or atherosclerosis (hardening of the arteries)

What Are the Symptoms of AAA?

AAA is sometimes called a “silent killer” because there are usually no obvious symptoms. When symptoms are present, they may include:

• severe abdominal pain (that may be constant or come and go)
• pain in the lower back that may radiate to the buttocks, groin or legs
• the feeling of a “heart beat” or pulse in the abdomen

In some, but not all cases, AAA can be diagnosed by a physical examination in which the doctor feels the aneurysm as a soft mass in the abdomen.

If an aneurysm expands rapidly, tears open or bursts, or if blood leaks along the wall of the blood vessel (aortic dissection), severe symptoms may develop suddenly. A ruptured aneurysm is life threatening and requires immediate emergency care. Symptoms of a ruptured aneurysm may include:

• severe pain that begins suddenly
• paleness
• rapid pulse
• dry mouth/skin and excessive thirst
• anxiety
• nausea and vomiting
• lightheadedness or fainting
• excessive sweating or clammy skin
• shock

If you experience these symptoms, seek immediate emergency care.

How Is AAA Treated?

If an aneurysm is small, it may require no treatment other than “watchful waiting.” The aneurysm should be monitored by a vascular specialist who will order periodic ultrasound exams or other tests to determine if the aneurysm is growing. Many aneurysms remain small and pose no significant risk.

Aneurysms greater than five centimeters in size are at greater risk for rupture and typically require treatment. Once an aneurysm has ruptured, the chances of survival are low, with from 80 to 90 percent of all ruptured aneurysms resulting in death. These deaths can be avoided if an aneurysm is detected and treated before it ruptures.

There are two methods to repair AAA:

• Open Surgical Repair. The most common treatment for a large, unruptured aneurysm is open surgical repair. An incision is made in the abdomen and the surgeon opens the aneurysm and sews in place a vascular graft – a tube made of cloth that lines the weakened area of the aorta, blocking the supply of blood to the aneurysm.
  
• Endovascular Stent- Graft Repair. In some cases, a less invasive technique called endovascular repair may be used. In this technique, a device called a stent-graft is threaded through a blood vessel in the groin and into the aorta to divert the flow of blood from the aneurysm. With this technique, there is no need to make a large incision in the abdomen or to cut away the damaged section of blood vessel.